Provider Demographics
NPI:1629513742
Name:PEDRO A ESPAT DO
Entity Type:Organization
Organization Name:PEDRO A ESPAT DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-589-5600
Mailing Address - Street 1:8005 BAY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3244
Mailing Address - Country:US
Mailing Address - Phone:772-589-5600
Mailing Address - Fax:772-589-9449
Practice Address - Street 1:8005 BAY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3244
Practice Address - Country:US
Practice Address - Phone:772-589-5600
Practice Address - Fax:772-589-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty